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Chapter 21
Translating Research into Practice
All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc.
Learning Outcomes
Value the individual nurse’s obligation to use research in practice.
Analyze the differences among evidence-based practice, and practice-based evidence, comparative effectiveness, and outcomes research.
Formulate a clinical question that can be searched in the literature.
Evaluate resources for the best available evidence.
All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 2
Learning Outcomes (Cont.)
Identify resources for critically appraising evidence.
Assess organizational barriers to and facilitators of the implementation of research findings.
Identify strategies for translating research into practice within the context of an organization.
All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 3
Societal Factors Influencing the Use of Research
Rising cost of health care Quality improvement initiatives Pressures to avoid errors Research about the costs of not
implementing evidence Publicity about research findings
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Research
“Diligent, systematic inquiry or investigation to validate and refine existing knowledge and generate new knowledge” (Burns & Grove, 2013, p. 1)
All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 5
Support for the Significance of Research in Practice
Nursing’s Social Policy Statement. (American Nurses Association [ANA], 2010).
Code of Ethics for Nurses. (ANA, 2001). Nursing: Scope and Standards of Practice.
(ANA, 2010). Nursing Research [Position Statement].
(International Council of Nurses, 2007)
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Expectations for Professionals
Knowing where and how to find the best possible sources of evidence
Formulating clear clinical questions Searching for relevant answers from the best
possible sources Determine when and how to integrate findings
into practice (Greiner & Knebel, 2003)
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Types of Research Use
Enlightenment Implementation of a research-based protocol Widespread adoption of standards based on
research findings
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Speaking of Research
Basic vs. applied Qualitative vs. quantitative Cross-sectional vs. longitudinal Descriptive vs. experimental Retrospective vs. prospective
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Research Application
Some research is ready for application. Some research is not yet ready for
application. Readiness for application is not necessarily
dependent on the research design. A single study may provide sufficient
evidence for implementation.
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National Institutes of Health Roadmap
New pathways to discovery New strategies for diagnosing, treating, and
preventing disease Research teams of the future
Interdisciplinary teams, public-private partnerships Reengineering the clinical research
enterprise Clinical research networks, policy analysis and
coordination, chronic disease outcomes, translational research
All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 11
American Recovery and Reinvestment Act of 2009
Set aside $1.1 billion for comparative effectiveness research
All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 12
Research Utilization
Use of knowledge from research to make a change in practice Example:
• Reading a research report on how to most effectively teach new mothers how to breast-feed
• Applying research results to the clinical setting
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Evidence-Based Practice (EBP)
Evidence-based medicine: integration of best research evidence with clinical expertise and the patient’s unique values and circumstances in making decisions about the care of individual patients. (Straus et al., 2011)
Use of evidence-based practice denotes use of evidence by all healthcare practitioners.
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Evidence-Based Practice (EBP) (Cont.)
Searching for the best research-based answer to a clinical practice problem Example:
• New mothers are not breast-feeding even after receiving instruction.
• Research-based protocol is developed based on the best scientific evidence about teaching breast-feeding.
Includes consideration of patients’ preferences
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Selected Practice Improvement Arenas
Preoperative teaching Pain management Assessment of children’s behavior Prevention of falls Pressure ulcer risk detection Incontinence care Family-centered care in intensive care
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Translation of Research into Practice (TRIP)
The science of how research is best translated into practice Example:
• The best strategies for getting staff members to use a new evidence-based protocol for teaching new mothers about breast-feeding
Also known as translation science
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Comparative Effectiveness Research
“Generation and synthesis of evidence that compares the benefits and harms of alternative methods to prevent, diagnose, treat, and monitor a clinical condition or to improve the delivery of care.” (Institute of Medicine, 2009, p. 29)
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Foundation for Comparative Effectiveness Research (CER)
Efficacy: testing an intervention or treatment in a traditional research study, such as a randomized clinical trial (RCT) under carefully controlled conditions
Effectiveness: testing whether an intervention works in the real world of practice with a focus on the decision needs of clinicians and patients
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Asking the Right Question: PICO Format
Patient population Intervention/interest area Comparison Outcome
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Practice-Based Evidence
A comparative effectiveness approach Research methodology that helps inform
practice decisions by examining outcomes in the real world, where patients may not be similar and the actual application of an intervention may have multiple variations
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Participatory Action Research
Members of the community being studied are integral members of the research team and are involved in identifying the questions and addressing the issues involved in the implementation of the research project (Chevalier & Buckles, 2013)
All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 22
Quality Improvement
Uses data to improve processes and outcomes of care (Shirey et al., 2011)
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Nurse-Sensitive Outcomes
Outcomes directly related to the quality of nursing care Examples:
• Falls• Nosocomial infections such as urinary tract infections• Pressure ulcers
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Patient-Centered Outcomes Research Institute (PCORI)
Created under auspices of the Centers for Medicare & Medicaid Services (CMS) by the Affordable Care Act (ACA) of 2010
Includes stakeholder input Focused on
Improving healthcare systems Communication and dissemination Addressing disparities Accelerating patient-centered outcomes research
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Diffusion of Innovations: Stages
Knowledge Exposure to information
Persuasion Attitude development
Decision Commitment to adoption
Implementation Application to practice
Confirmation
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Knowledge Stage
Information dissemination Journals Conferences Educational programs Media
Literature review
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Persuasion Stage
Informal communication networks Use of a champion Attitudes may be positive or negative.
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Decision Stage
Commitment to adoption Innovation might be adopted. Innovation might be rejected.
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Implementation Stage
Direct application Exactly as it was done in previous research Exactly as recommended in a guideline
Reinvention Modified to suit the environment
Indirect application Modified according to the needs and values of the
staff
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Confirmation Stage
Evaluating the innovation Make a decision
• Continue• Discontinue• Modify
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Characteristics of Innovation Adopters
Innovators Early adopters Early majority Late majority Laggards
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Stetler’s Research Utilization Model to Facilitate Evidence-Based Practice
Preparation Validation Evaluation/decision making Translation/application Evaluation
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Steps in Evidence-Based Practice
Asking the relevant clinical question Searching for the best evidence Critically appraising evidence Integrating evidence with clinical expertise,
patient preferences, and values in making a practice decision or change
Evaluating the practice decision or change
From Melnyk, B.M., & Fineout-Overholt, E. (2005). Making the case for evidence-based practice. In B.M. Melynk, & E. Fineout-Overholt (Eds.), Evidence-based practice in nursing and health care (p. 9). Philadelphia: Lippincott, Williams & Wilkins.
All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 34
Individual Strategies for EBP
Identify challenges in providing care. Ask questions about agency practices. Ask for the evidence underlying practices.
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Research Networks
Practice-based research networks (PBRNs) Electronic data-sharing consortia Veterans Administration (VA) Quality
Enhancement Research Initiative (QUERI) Magnet
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Translating Research into Practice (TRIP)
“Scientific investigation of methods and variables that affect adoption of evidence-based healthcare practices by individual practitioners and healthcare systems to improve clinical and operational decision-making… … includes testing the effects of strategies to promote and sustain evidence-based practices.”
(Titler, 2004, p. 38)
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Organizational Issues
Lack of resources Limited expertise of staff members Lack of knowledge about nursing research Limited time for planning
All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. 38
Organizational Strategies
Create partnerships between nurses and researchers
Involve key decision makers Understand organizational context Support a research culture Build capacity and infrastructure Formulate staff expectations recognition Provide technical support
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Strategies for Nurse Leaders and Managers
Partnering with nurse researchers in academia
Collaborating with interdisciplinary team members
Joining practice-based research networks Establishing journal clubs Using nurses associations’ resources for
policy and research Publicizing successes
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